Endoscopic screening for esophageal cancer in high-risk patients

July's issue of Endoscopy reports that cancer endoscopic screening using Lugol staining is justified with head and neck cancer due to the high prevalence of esophageal cancer in these patients.

The prevalence of esophageal squamous-cell carcinoma in high-risk patients has not yet been evaluated in a large prospective study.

The advantages of systematic Lugol staining during esophagoscopy has also not yet been assessed within this context.

Dr Dubuc and colleagues from France assessed the prevalence of this type of tumor in high-risk patients.

The research team examined the role of Lugol staining in endoscopic screening for esophageal squamous-cell carcinoma.

The team established whether it is possible to identify a particularly high-risk group which would benefit from systematic screening.

A prospective study was undertaken in 62 endoscopy centers.

75% of lesions in Group 1 were only diagnosed after Lugol staining

Endoscopy

The team enrolled a total of 1095 patients divided into 4 groups, none of whom had any esophageal symptoms.

Patients in Group 1 had presented with either a past history of or a recent head and neck or tracheobronchial squamous-cell carcinoma.

Group 2 included patients with alcoholic chronic pancreatitis, while Group 3 had patients with alcoholic cirrhosis.

The team included patients who were alcohol and tobacco addicts in Group 4.

The patients underwent a meticulous endoscopic examination of the esophagus, followed by Lugol staining.

The researchers found that the prevalence of esophageal squamous-cell carcinoma was 3%.

The Group 1 patients showed the highest prevalence of carcinoma at 5%, and the highest prevalence of dysplasia at 4%.

Of the 35 carcinomas detected in the 1095 patients, the team noted that 20% were early lesions, and 20% were only detected after Lugol staining.

The researchers observed high grade dysplasia only in Group 1 patients and 75% of these lesions were only diagnosed after Lugol staining.

The overall prevalence of low-grade dysplasia was 2%.

The researchers detected 77% of these only after Lugol staining.

Dr Dubuc's team commented, “Lugol dye staining increases the sensitivity of esophageal endoscopy for the detection of high-grade dysplasia and cancer.”

“The prevalence of dysplasia and cancer reached 10% in Group 1.”

“We therefore believe that an endoscopic screening program could be justified for patients with head and neck or tracheobronchial cancer.”